In spite of tremendous advancement in the field of cardiovascular medicine and surgery the mobidity and mortality due to Coronary Heart Disease is still increasing in almost all the society. Worldwide attempt are being made to prevent coronary heart disease by modifying various risk factors. The alternate strategy that has gained wide spread application in the recent years is secondary prevention.
Coronary Heart Disease (CHD) is the leading cause of morbidity and mortality in many developed countries and will be an increasing problem for developing countries. Recognition of the alarming risk of CHD among South Asian Nations has led to take initiatives focusing on understanding of pathophysiological mechanisms and emphasis has been given on establishment of new remedial measures for cardio protection. Several but not all, of the known risk factors for CHD have been associated with a level of oxidative stress including use of tobacco, hypertension, dyslipidemia, obesity and diabetes. A production of oxidative stress, LDL-oxidation has been hypothesized as primary underlying mechanism for the development of atherosclerosis and CHD.
Abnormal blood lipid is the most important causative factor of Coronary Heart Disease. The association between serum cholesterol level and coronary heart disease is widely studied by several workers. Elevated serum Triglycerides and low HDL-c level is an independent risk factor of CHD.
Various epidemiological studies have shown that increased levels of serum lipoprotein (a), homocysteine, fibrinogen, insulin resistance and thrombogenic factors are strongly associated with the increased CHD risk. These fast emerging risk factors have strong genetic predisposition and have their beginning in early childhood. It showed presence of elevated markers like CRP and Homocysteine in school going children.
The level of homocysteine, a sulfydryl-containing amino acid and C-reactive protein (CRP), a protein found in the blood circulation, has shown to be predictive of future Coronary Heart Disease (CHD). There is also evidence that the elevated range of homocysteine and CRP concentration has association with atherosclerosis and thrombosis observed in many cases.
The American Heart Association and the Centre for Disease Control and prevention, released a scientific statement regarding clinical assessment of inflammatory markers IL-6, TNF-α including CRP as a predictor for risk for cardiac event.
It has been observed in several cases and also among the patient suffered from vascular disease that, genetic factor influence plasma homocysteine concentration. It is also reported that homocysteine rise with age in both men and women and its concentration are higher in men than women. This may be due to difference in muscle mass and renal function. Sex hormones may also influence homocysteine concentration in plasma.
As pointed out earlier that elevated plasma homocysteine is a known factor for atherosclerotic vascular disease, it further increases the risk, associated with smoking and hypertension. Dietary regulation like folate, cobalamin and pyridoxal phosphate, modulate homocysteine metabolism.
Homocysteine level rise with decreasing concentration of vitamin B6, vitamin B12 and folate, further it increases due to their impaired metabolism by the kidneys and liver which enhances the risk of myocardial infarction and stroke. Certain drugs like
combination of colestipol and niacin, methotrexate, phenytoin carbomazepine and nitrous oxide may increase homocysteine concentration in plasma. Further, it is pointed out that patients with inherited defects of methionine metabolism can develop severe hyperhomocysteinemia and can have premature atherothrombosis. Though a mild to moderate elevation of homocysteine are common in general population due to insufficient dietary intake of folic acid.
Level of CRP is an acute phase marker and a predictor of the risk of atherosclerotic complication. High level of CRP is a significant marker of inflammation and it consistently predicts new coronary events in patients with unstable angina and acute myocardial infarction. It is reported that individuals with high-CRP levels has relative risks of future vascular events, three or four times higher than individuals with lower levels. Higher CRP may cause heart attack and is associated with lower survival rate of people. The other risk factors of CHD include lipoprotein remnants, lipoprotein (a), small LDL particles, HDL subspecies and various apolipoproteins including coronary calcium. It is widely accepted that evaluating CRP as a risk factor for CHD is of clinical significance in the prevention and management of CHD. High Body Mass Index (BMI) and insulin resistance are also contributing factors for CHD.
Resistin has been considered as one of the most important inflammatory markers responsible for endothelial dysfunction, atherosclerosis and cardiovascular disorder. Plasma resistin level are highly correlated with level of diverse inflammatory markers, particularly circulating TNF-α, IL-6, hs-CRP and lipoproteins. The resistin is directly associated with the level of adiponectin which has shown association with diabetes and Metabolic syndrome. Recent studies have demonstrated the association of adiponectin with diabetes mellitus and its potential anti-diabetic, anti-atherogenic and anti-inflammatory activities.
Psychological stress also plays an important role in precipitation of arterial hypertension, angina and myocardial infarction. Therefore stress management also contributes in the prevention of CHD.
Keeping the above background in to consideration it was decided to propose a safer remedial measure for the improvement in atherosclerotic process, reduction in high level of homocysteine and the inflammatory marker C-reactive protein, IL-6, resistin and abnormal lipids responsible for an adverse cardiac event.
Scientific evaluation of some of the Ayurvedic drugs have shown better efficacy over standard pharmacologic therapy as well as reduced side effects. The successful management of CHD is seldom possible with one drug alone. Generally it is observed that due to inadequate response of the drugs and troublesome side-effects the currently available drugs are not able to reduce the mortality and morbidity rate from CHD. It has long been recognized that the desirable action of the drugs conventionally used in CHD cases could be augmented and undesirable actions may be minimized by the use of two or more drugs in appropriate combination. In classical texts of Ayurveda many plant based drugs have been advocated for the prevention and management of cardiovascular disorders, without any adverse reaction. Ayurveda has given a comprehensive description about etiopathogenesis and management of coronary heart disease. Several single and combined formulations have been described in Ayurveda for the management of heart diseases. It includes all risk factors and their management. Taking the lead from ancient Indian literature it was thought to propose an Ayurveda formulation having multi-targeted action in CHD cases as well as CHD risk factors with the object to prevent the morbidity and mortality from CHD.